TOIL for toil – motivating staff to achieve NEAT targets

Ms Kim Jackson1, Ms Hannah Putland1, Ms Cassandra  Rooney1, Ms Karen Robinson1, Ms Ruth Jebb1, Ms Emily Cooper1, Ms Dale Mason1, Dr Amy Johnston1,2, Mrs Susan Sivyer1

1Princess Alexandra Hospital, Department Of Emergency Medicine And Sonmsw University Of Queensland, Brisbane, Australia, 2University of Queensland, School of Nursing, Midwifery and Social Work, Brisbane, Australia

In 2012, responding to evidence that Emergency Department (ED) crowding and extended periods of care in EDs increased patient morbidity and mortality, a national partnership agreement directed implementation of the National Emergency Access Targets (NEAT)[1]. These were to be incrementally increased to predetermined levels over a period of years. EDs not meeting these targets faced risks of increased oversight and even financial penalty. This presentation describes an innovative clinical process developed in one ED that took the opposite approach. Rather than penalize for non-compliant operational processes, this Magnet facility took the view that providing staff with reward for achieving targets would motivate and enhance performance. In early 2017, a system of limited time off in lieu (TOIL) for clinical staff on shift when key subunits of the ED achieved 100% NEAT compliance was introduced. A series of staff-developed conditions to guide and frame compliance in the context were developed in collaboration with a range of nursing staff and are applied every day. The processes were reviewed by ED medical and nursing staff and approved institutionally. Acknowledgement of TOIL (and the staff responsible for TOIL) is provided by way of an ED wide congratulations email – to further recognise the commitment of these staff and motivate others. Curiously, staff often do not access the TOIL –recognition of staff responsibility for smooth and effective achievement of key performance indicators appears to be a desired end goal. Staff suggest that while 100% NEAT compliance often remains elusive, this element of positive recognition of clinical commitment enhances staff perception of their working environment and provides impetus to deliver timely care without compromising care quality.

[1]. Sullivan et al., 2014. Aiming to be NEAT: safely improving and sustaining access to emergency care in a tertiary referral hospital. Australian Health Review, 38(5), 564-574.


This project was developed and is presented by a team of innovative ED CNCs with a keen interest in providing ED patients with the best possible care processes. They work as part of a dedicated and committed team of ED staff to ensure best possible processes are developed, trialled, implemented and then evaluated in the ED space.